Vital signs - Respiration

Vital signs - Respiration

1. Respiration PREPARED BY: USHA RANI KANDULA, ASSISTANT PROFESSOR, DEPARTMENT OF ADULT HEALTH NURSING, ARSI UNIVERSITY,ASELLA,ETHIOPIA, SOUTH EAST AFRICA.

2. Respiration Respiration is the interchange of oxygen (O2) and carbon dioxide (CO2) between the atmosphere and the body and involves both external respiration and internal respiration.

3. External Respiration is the exchange of these gases between the lungs’ alveoli and the blood found in the capillaries that surround the alveoli.

4. Internal respiration Internal respiration is the process of exchanging gases between the circulating blood and the tissue cells that make up the body.

5. ventilation The movement of air into and out of the lungs is known as ventilation.

6. mechanics of respiration The mechanics of respiration involve the act of breathing in, termed as Inhalation or inspiration, and breathing out, described as Exhalation or expiration.

7. Although the act of breathing is a function of the respiratory system, it is regulated by the central nervous system, specifically by the medulla oblongata and the pons , two structures of the brainstem, and by chemoreceptors in the carotid and aortic bodies.

8. Hypoxemia. The carotid body is a section of the carotid artery wall, and the aortic body is a section of the aortic arch wall, both of which contain chemical receptor sites that detect decreases in the blood level of O2, known as Hypoxemia.

9. When hypoxemia is detected, electrical impulses are generated and sent via nerves to the medulla, which will then increase the respiratory rate or depth as needed to correct the hypoxemia.

10. Inspiration To effect inspiration, the medulla sends an impulse via the phrenic nerves to the diaphragm muscle and along the intercostals nerves to the intercostal muscles, telling the muscles to contract.

11. The contraction of the diaphragm causes it to flatten and move downward, while the contraction of the intercostals muscles results in pulling the ribs upward and outward, enlarging the chest cavity.

12. Expiration Once the medulla stops sending the motor impulses to inhale, the intercostal and diaphragm muscles begin to relax, once again shrinking the thoracic or chest cavity to the smaller, pre-inhalation state and compressing the lungs.

13. The elastic connective tissue of the alveoli recoils somewhat like a rubber band, forcing the air that is mostly CO2 out of the alveoli so that it can be exhaled and returned to the atmosphere.

14. Assessing Respiration

15. Assessing Respiration The only equipment required to assess respiration is a watch with a second hand.

16. Assess respiration for: Rate per minute Depth Rhythm Pattern Respiratory effort

17. Because individuals can voluntarily control their breathing for short intervals of time, it is best to assess the respirations without the patient’s awareness.

18. This may be accomplished by positioning the patient’s arm across his or her chest or abdomen.

19. Feel for the radial pulse and hold the pulse site while you assess first the respirations and then the radial pulse.

20. It will appear that you are simply taking the patient’s pulse, and this will help to distract the patient from concentrating on his or her breathing.

21. While pressing two fingers against the pulse site, count the respiratory rate for 30 seconds and multiply times two for a 1-minute rate, and then continue to palpate the radial pulse site to assess the pulse rate.

22. If the patient is very ill or respirations deviate in any manner from the norm, assess for a full minute.

23. Rate per minute Each respiration consists of one Inspiration and one expiration. Observe the rise and fall of the chest or abdomen to count the rate. The normal rate for adults is between 12 and 20 bpm .

24. eupnea When the rate, depth, rhythm, pattern, and respiratory effort fall within normal parameters, the term eupnea is used to describe the respirations.

25. Bradypnea and tachypnea Bradypnea describes a respiratory rate below 12 respirations per minute; when the rate exceeds 20 respirations per minute, the term is Tachypnea .

26. When the breathing rate slows, it results in a decreased intake of O2 that can result in a deficiency of O2 in the tissues and cells.

27. apnea When respirations cease or are absent, this is known as Apnea . You have only a brief window of 3 to 5 minutes in which to restore respirations before brain damage and death occur.

28. Because the heart and lungs work together to provide circulation of nutrients and oxygen, the factors that affect the heart rate generally affect the respiratory rate as well.

29. For example, as fever raises the pulse rate, it will also increase the respiratory rate.

30. Breathing speeds up in an attempt to meet the body’s increased metabolic needs and to remove excess heat.

31. For every 1°F rise in body temperature, the respiratory rate increases approximately four breaths per minute.

32. Depth The depth of respiration is observed by the amount of chest expansion with each breath and is related to the volume of air that is inhaled.

33. The average amount of air inhaled in one breath is between 300 and 500 mL and is known as the tidal volume, which can be assessed with special equipment.

34. Without special equipment, you can onlyn observe the rise and fall of the chest to provide a subjective measurement of the depth, usually described as shallow, normal, or deep.

35. Rhythm and Pattern The rhythm of normal respirations is one that is regular, or has evenly spaced intervals between the respirations.

36. When the intervals are not consistent, you assess them as irregular.

37. When the rhythm is irregular, further assess the respirations to determine if the respirations fall into certain patterns.

38. Respiratory Effort Respiratory effort refers to the amount of work required to breathe. Normally, the act of breathing is effortless and is performed unconsciously.

39. dyspnea An individual who is having labored or difficult breathing is said to be having Dyspnea .

40. The severely dyspneic patient will usually appear frightened, anxious, or worried.

41. The first thing you may notice when you look at the patient is a “wide-eyed” or startled appearance.

42. This may be indicative that the impaired gas exchange has progressed to the point of hypoxemia or hypoxia .

43. Hypoxemia Hypoxemia is the term used to denote a decreased oxygen level in the blood.

44. If hypoxemia is not relieved, hypoxia, or decreased delivery of oxygen to the tissues and cells, occurs.

45. Often the patient does not appear to have dyspnea until he or she begins to exert energy, which increases the body’s metabolic demand for oxygen.

46. Exertional dyspnea Exertional dyspnea only occurs during activities such as speaking, eating, repositioning, or ambulating.

47. sign of difficult breathing Another sign of difficult breathing is use of the accessory respiratory muscles: the neck and abdominal muscles.

48. It is important to assess which activities result in exertional dyspnea , document findings in the patient’s record, and report such findings to the RN supervisor.

49. orthopnea Some patients find it too difficult to breathe unless positioned in an upright position, such as sitting or standing. This condition is known as orthopnea .

50. Characteristics of respiration

51. Related Characteristics Other respiratory assessments go hand in hand with those previously detailed, including the audible sounds during ventilation and the breath sounds that are auscultated with a stethoscope:

52. Stertorous breathing Stertorous breathing refers to noisy, snoring, labored respirations that are audible without a stethoscope.

53. Adventitious sounds Adventitious sounds are abnormal sounds that may be heard when auscultating the lungs with a stethoscope and include wheezes, rales or crackles, rhonchi , and stridor .

54. Wheezes Wheezes are musical, whistling sounds that may be audible without a stethoscope or heard only during auscultation.

55. Rales , or crackles, are adventitious sounds Rales , or crackles, are adventitious sounds that may be auscultated with a stethoscope and are the result of air moving over secretions in the lungs.

56. Rales are short, choppy, popping, snapping, or raspy sounds that may resemble the sound made by rubbing strands of hair between your thumb and index finger.

57. Rales may be classified as fine or coarse depending on their characteristics.

58. Rhonchi Rhonchi are continuous, low-pitched, rattling or bubbling, snoring or sonorous wheezing sounds that can be auscultated when there is partial obstruction of the larger airways due to secretions or tumor.

59. Stridor Stridor is an audible, high-pitched crowing sound that results from partial obstruction of the airways.

60. Factors Affecting Respiratory Rate

61. According to Age Normal respiratory rates: Newborns: 30–60 Infants: 20–40 Children: 20–30 Adolescents: 14–25 Adults: 12–20

62. Smoking - Increase Environmental temperature -Heat: Increase -Cold: Decrease Exercise, exertion - Increase

63. Rest, sleep, meditation - Decrease Pain, anxiety, stress, fear - Increase Medications, such as narcotics and sedatives-Decrease

64. Drug overdose, such as aspirin- Increase Respiratory diseases, such as asthma and emphysema - Increase

65. Metabolic acidosis, such as caused by diabetes - Increase Metabolic alkalosis, such as caused by severe vomiting - Decrease

66. Increased intracranial pressure- Decrease

67. Abnormal Respiratory Patterns

68. Cheyne -Stokes Respirations Respirations begin shallow, gradually increase in depth and frequency to a peak,

69. Then begin to decrease in depth and frequency until slow and shallow; this is followed by a period of apnea lasting from 10 to 60 seconds. Pattern is repetitious.

70. Kussmaul’s respirations Respirations are increased in rate and depth, with long, strong, blowing or grunting exhalations.

71. Biot’s Respirations Respirations are grouped as several shallow breaths followed by variable-length periods of apnea.

72. THANKING YOU